{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:41:13Z","timestamp":1785400873227,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006546","name":"Angelini Pharma","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006546","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/05bz49965","id-type":"ROR","asserted-by":"publisher"}]},{"name":"EDRA S.p.A."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Background: Acute sore throat (pharyngitis) accounts for 10\u201330% of ambulatory visits annually. Bacterial etiology, primarily Group A Streptococcus, is confirmed in only 20\u201334% of cases, and inappropriate antibiotic administration remains frequent, contributing to antimicrobial resistance. Community pharmacists play a key role in symptomatic management and stewardship, but real-world practices remain underexplored. Methods: A 16-item online questionnaire surveyed 629 Italian community pharmacists via professional networks, covering demographics, diagnostic tools, symptom assessment, treatment preferences, and follow-up. Responses were analyzed using descriptive statistics and interpreted within a multidisciplinary expert framework. Results: Italian community pharmacists (n = 629), predominantly mid-career and experienced individuals, prioritize targeted symptom questioning (flu-like signs (59.96%), fever (48.73%), pain intensity (49.64%)) and medical referral over formal diagnostic tools like the Centor criteria (unused in 53.66% of cases). A total of 46.74% report performing a Strep A test in fewer than 20% of patients. Topical sprays (83.33%) and lozenges (44.69%), especially containing flurbiprofen (94.19%), dominate recommendations, followed by systemic analgesics (45.79%). For mild cases, anti-inflammatory\/analgesic sprays\/lozenges (35.42%) and antiseptic lozenges (35.61%) dominate, while in severe cases, drugs with anti-inflammatory or analgesic effects are often preferred (72.47%). Most pharmacists request a follow-up (73.22%). Conclusions: Italian community pharmacists report a predominantly topical-first approach focused on symptomatic treatment and referral when appropriate. Diagnostic gaps and inconsistent follow-up represent actionable targets. The findings inform training outputs prioritizing simplified triage, expanded symptom checklists, spray\/lozenge optimization, and 3\u20135-day call-backs. This work aims to promote pharmacists\u2019 antimicrobial stewardship to reduce antibiotic use while enhancing patient-centred sore throat care in Italy\u2019s pharmacy network.<\/jats:p>","DOI":"10.3390\/pharmacy14050110","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T01:26:23Z","timestamp":1785115583000},"page":"110","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Acute Sore Throat in Community Pharmacies: Insights from a Survey of Italian Pharmacists"],"prefix":"10.3390","volume":"14","author":[{"given":"Rachele","family":"Aspesi","sequence":"first","affiliation":[{"name":"Ordine dei Farmacisti di Varese, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4730-8656","authenticated-orcid":false,"given":"Paolo","family":"Levantino","sequence":"additional","affiliation":[{"name":"Federazione Nazionale Associazioni Giovani Farmacisti (Fenagifar), 00199 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Ciancarella","sequence":"additional","affiliation":[{"name":"SIMG (Italian College of General Practitioners and Primary Care), Lazio Regional Section, 00196 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Nacci","sequence":"additional","affiliation":[{"name":"ENT, Audiology, and Phoniatrics Unit, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2952-8989","authenticated-orcid":false,"given":"Pietro","family":"Tasegian","sequence":"additional","affiliation":[{"name":"SIMG (Italian College of General Practitioners and Primary Care), Umbria Regional Section, 06012 Citt\u00e0 di Castello, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego Maria Michele","family":"Fornasari","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnology and Translational Medicine, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1111\/jcpt.13012","article-title":"Topical (Local) Antibiotics for Respiratory Infections with Sore Throat: An Antibiotic Stewardship Perspective","volume":"44","author":"Essack","year":"2019","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Essack, S., Bell, J., Burgoyne, D., Tongrod, W., Duerden, M., Sessa, A., Altiner, A., and Shephard, A. (2020). Point-of-Care Testing for Pharyngitis in the Pharmacy. Antibiotics, 9.","DOI":"10.3390\/antibiotics9110743"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"ESCMID Sore Throat Guideline Group, Pelucchi, C., Grigoryan, L., Galeone, C., Esposito, S., Huovinen, P., Little, P., and Verheij, T. (2012). Guideline for the Management of Acute Sore Throat. Clin. Microbiol. Infect., 18, 1\u201328.","DOI":"10.1111\/j.1469-0691.2012.03766.x"},{"key":"ref_4","unstructured":"(2026, January 06). Adherence to NICE Guidelines and Centor Criteria in Acute Sore Throat Management: An Audit Cycle | Cureus. Available online: https:\/\/www.cureus.com\/articles\/409507-adherence-to-nice-guidelines-and-centor-criteria-in-acute-sore-throat-management-an-audit-cycle#!\/."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Anello, P., Vianello, S., Baldo, V., Frasson, E., Gallo, U., Rampazzo, R., Marchiori, M., Carraro, M., Marchiori, S., and Pigozzo, M. (2025). Antimicrobial Stewardship and Infection Prevention and Control in the Veneto Region, Northeastern Italy: Governance Models, Resources, and Key Challenges Across Hospital and Community Settings-Findings from the ARCO Project. Microorganisms, 13.","DOI":"10.3390\/microorganisms13020405"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1136\/ejhpharm-2020-002242","article-title":"Role of the Hospital Pharmacist in an Italian Antimicrobial Stewardship Programme","volume":"29","author":"Polidori","year":"2022","journal-title":"Eur. J. Hosp. Pharm."},{"key":"ref_7","first-page":"1","article-title":"The Role of the Community Pharmacy in the Fight against Antimicrobial Resistance: A Survey in Italy","volume":"24","author":"Francesca","year":"2026","journal-title":"Pharm. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e02729-20","DOI":"10.1128\/AAC.02729-20","article-title":"Antibiotic-Dispensing Practice in Community Pharmacies: Results of a Cross-Sectional Study in Italy","volume":"65","author":"Bianco","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.ijporl.2010.02.020","article-title":"The Sensitivity and the Specifity of Rapid Antigen Test in Streptococcal Upper Respiratory Tract Infections","volume":"74","author":"Gurol","year":"2010","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_10","unstructured":"(2026, June 28). A Consensus-Based Checklist for Reporting of Survey Studies (CROSS) | EQUATOR Network. Available online: https:\/\/www.equator-network.org\/reporting-guidelines\/a-consensus-based-checklist-for-reporting-of-survey-studies-cross\/."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bia\u0142a, M., Babicki, M., Malchrzak, W., Janiak, S., Gajowiak, D., \u017bak, A., K\u0142oda, K., Gibas, P., Ledwoch, J., and My\u015bliwiec, A. (2024). Frequency of Group A Streptococcus Infection and Analysis of Antibiotic Use in Patients with Pharyngitis\u2014A Retrospective, Multicenter Study. Pathogens, 13.","DOI":"10.3390\/pathogens13100846"},{"key":"ref_12","first-page":"e2023219","article-title":"Antibiotic Treatment for Streptococcal Pharyngitis: Time for a New Approach?","volume":"94","author":"Curatola","year":"2023","journal-title":"Acta Biomed."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1093\/jac\/dkad388","article-title":"A Pharmacy-Led Sore Throat Test and Treat (STTT) Service: Antigen Testing and Antibiotic Supply Rates during the Period of Heightened Public Awareness of Group A Streptococcus Infections","volume":"79","author":"Mantzourani","year":"2024","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Merks, P., Sikorski, S., Religioni, U., \u015awietlik, D., Plagens-Rotman, K., Drelich, E., Ka\u017amierczak, J., Krolak-Uli\u0144ska, A., Sierpi\u0144ski, R., and Doniec, Z. (2025). Effectiveness of Pharmaceutical Counseling in Sore Throat Management According to Patients and Pharmacists. Healthcare, 13.","DOI":"10.3390\/healthcare13212708"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e000833","DOI":"10.1136\/bmjoq-2019-000833","article-title":"Impact of a Pilot NHS-Funded Sore Throat Test and Treat Service in Community Pharmacies on Provision and Quality of Patient Care","volume":"9","author":"Mantzourani","year":"2020","journal-title":"BMJ Open Qual."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.japh.2022.10.013","article-title":"Global Engagement of Pharmacists in Test and Treat Initiatives: Bringing Care from Clinics to Communities","volume":"63","author":"Smith","year":"2023","journal-title":"J. Am. Pharm. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"108209","DOI":"10.1016\/j.ijid.2025.108209","article-title":"Evaluating the Modified Centor Criteria as a Screening Tool before Polymerase Chain Reaction Testing and Antibiotic Use for Group A Streptococcus Pharyngitis in a VA Population","volume":"163","author":"Schmaltz","year":"2026","journal-title":"Int. J. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e13272","DOI":"10.1111\/ijcp.13272","article-title":"Efficacy and Safety of a Triple Active Sore Throat Lozenge in the Treatment of Patients with Acute Pharyngitis: Results of a Multi-Centre, Randomised, Placebo-Controlled, Double-Blind, Parallel-Group Trial (DoriPha)","volume":"72","author":"Palm","year":"2018","journal-title":"Int. J. Clin. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.2147\/JPR.S135602","article-title":"Efficacy of Flurbiprofen 8.75 Mg Delivered as a Spray or Lozenge in Patients with Sore Throat Due to Upper Respiratory Tract Infection: A Randomized, Non-Inferiority Trial in the Russian Federation","volume":"10","author":"Radkova","year":"2017","journal-title":"J. Pain Res."},{"key":"ref_20","first-page":"188","article-title":"Sore Throat","volume":"118","author":"Berner","year":"2021","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"f6867","DOI":"10.1136\/bmj.f6867","article-title":"Predictors of Suppurative Complications for Acute Sore Throat in Primary Care: Prospective Clinical Cohort Study","volume":"347","author":"Little","year":"2013","journal-title":"BMJ"},{"key":"ref_22","unstructured":"International Pharmaceutical Federation (FIP) (2022). Sore Throat: Quick Reference Guide for Pharmacists, International Pharmaceutical Federation."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1080\/23744235.2023.2191714","article-title":"Best Management of Patients with an Acute Sore Throat\u2014A Critical Analysis of Current Evidence and a Consensus of Experts from Different Countries and Traditions","volume":"55","author":"Gunnarsson","year":"2023","journal-title":"Infect. Dis."},{"key":"ref_24","first-page":"8","article-title":"Mal di Gola: Antibiotico o Non Antibiotico? Ultime evidenze","volume":"31","author":"Tasegian","year":"2024","journal-title":"Riv. SIMG"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Draga\u0161, E., Tomljenovi\u0107, D., Ra\u0161i\u0107, I., \u010culina, I.J., Svetina, L., Geber, G., Vagi\u0107, D., and Ko\u0161ec, A. (2025). Efficacy of Locally Applied Flurbiprofen in Sore Throat Treatment: A Scoping Review. Biomedicines, 13.","DOI":"10.3390\/biomedicines13123035"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1080\/03007995.2016.1187119","article-title":"Efficacy of Flurbiprofen 8.75\u2009Mg Lozenge in Patients with a Swollen and Inflamed Sore Throat","volume":"32","author":"Aspley","year":"2016","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3109\/13814788.2016.1145650","article-title":"Efficacy of Flurbiprofen 8.75\u2009Mg Spray in Patients with Sore Throat Due to an Upper Respiratory Tract Infection: A Randomised Controlled Trial","volume":"22","author":"Russo","year":"2016","journal-title":"Eur. J. Gen. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.2147\/PPA.S176683","article-title":"Application of Once-Monthly Self-Reported ACT Questionnaire in Management of Adherence to Inhalers in Outpatients with Asthma","volume":"14","author":"Zhang","year":"2020","journal-title":"Patient Prefer. Adherence"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103778","DOI":"10.1016\/j.gerinurse.2025.103778","article-title":"Professionals\u2019 Perspectives on Factors Influencing Adherence to Inhaler Medication in Patients with COPD and Asthma: A Qualitative Study","volume":"68","author":"Yin","year":"2026","journal-title":"Geriatr. Nurs."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Milushewa, P., Chenesheva, N., and Petkova, V. (2026). Self-Management, Adherence, and the Role of Pharmaceutical Care in Patients with T2DM in Primary Practice: A Cross-Sectional Survey in Bulgaria. Pharmacy, 14.","DOI":"10.3390\/pharmacy14010035"}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/5\/110\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:16:55Z","timestamp":1785125815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/5\/110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["pharmacy14050110"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy14050110","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,25]]}}}